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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343622941
Report Date: 09/17/2021
Date Signed: 09/17/2021 02:45:00 PM

Document Has Been Signed on 09/17/2021 02:45 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833
FACILITY NAME:MCLORIN-JACKSON,SONYAFACILITY NUMBER:
343622941
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY: 8TOTAL ENROLLED CHILDREN: 0CENSUS: 7DATE:
09/17/2021
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Sonya MClorin-JacksonTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Christopher Bello arrived at the facility at approximately 2:00pm and met with licensee Sonya MClorin Jackson for a Case Management Licensee Initiated inspection. The purpose of the inspection was for a capacity increase from 8 to 14 children. LPA Bello toured all areas of the home that are accessible to children, today’s census included seven children. No other adults were present during today's inspection. LPA observed the licensee not wearing a mask. LPA consulted with the licensee regarding wearing a mask during daycare hours.

Off-limit areas include: all bedrooms, garage and side yard. Licensee acknowledged that children may never enter these off-limit areas.

Licensee acknowledges that when there is no assistant present, facility will revert back to the small capacity. Licensee acknowledges that children residing in the home under the age of 10 years shall be included in capacity.

In the areas that were evaluated, no deficiencies were observed at the time of the visit.

MISSING ITEMS

The following to be submitted prior to licensure:
1) Fire Clearance

Effective after completion of above requirement. LPA will grant a license to serve 12 children (when there is an assistant present) with no more than 4 infants or capacity of 14 children when 1 child in kindergarten or elementary school and 1 child at least age 6 and a maximum of 3 infants. Infants are children under the age of 2 years old. An exit interview was conducted and notice of site visit was provided.
SUPERVISORS NAME: Roxana Saravia
LICENSING EVALUATOR NAME: Christopher Bello
LICENSING EVALUATOR SIGNATURE: DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/17/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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